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A 50 yr old woman has progressive dyspnea over past 2 wks and constant sharp, chest pain for 4 days. The pain is localized to the center of the chest and worsens on lying supine. She underwent rt modified radical mastectomy and adjuvant chemotherapy for breast cancer 3 yrs ago. She has a h/o of hypothyroidism treated with hormone replacement therapy. She has smoked 1 pack of cigarettes for past 30 yrs and drinks 2 ounces of alcohol daily. She is dyspneic and diaphoretic. Her temp is 37.2, BP 90/70, pulsus paradoxus of 20 mm Hg, pulse 110, resp 28/min. Exam shows jugular venous distension to the angle of the mandible. The liver span is 14 cm with 4 cm of shifting dullness. Arterial Bld gas analysis: pH 7.50, pCO2 30 and pO2 70. x ray chest enlarged cardiac silhouette with globular configuration. ECG: sinus tachycardia and non-specific ST segment changes diffusely. Most appropraite next step in management:
1. Echo
2.CT abdomen
3. venti-perfusion scan'
4.Bronchoscopy
5.paracentesis
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BP 90/70, pulsus paradoxus of 20 mm Hg,jugular venous distension , x ray chest enlarged cardiac silhouette with globular configuration, The pain worsens on lying supine
She has cardiac tamponade
need thoraxcentesis right away, not paracentesis.
so i'll chose Echo.
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Echo should be the right answer
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Echo.
What if there was pericardiocentesis [or pericardiowindow] in the options, would echo still be the right choice? Alibism
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i think then,,,,,,,,better to choose pericardiocentesis
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5.paracentesis
surgery kaplan says: you do not need ultrasound to confirm your Dx of cardiac temponade.
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letusdoit, do you mean pericardiocentesis? Paracentesis does not sound o.k
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I will go for 3. V/Q scan. because,
There's no doubt that pt has Tamponade, but another sign abnormal is Po2 = 70, pco2 = 30? Is there any problem with PE? Go for 3.
Correct me if i'm wrong
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PROGRESSIVE DYSPNEA is the problem.......V/Q cant be the choice......for it...there should be ACUTE DYSPNEA.
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i go in favor of paracentesis
pt is in distress--xray already said it cardiac effusion--echo is not the treatment--question is not about diagnosis question is about treatment
besides pt has respiratory alkalosis and dyspnea and he cannot breath he has tachpnea and the breathing should be taken care before circulation --so paracentesis is my answer here --
and i think that s what question is all about
and after that i will do pericardiocentesis //but echo is not my answer
now dont call it djyotism --i think we shud talk to cardiologist
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